Immediate and longitudinal effects of maltreatment on systemic inflammation in young children

Lingering Effects of Early Institutional Rearing and Cytomegalovirus Infection on the Natural Killer Cell Repertoire of Adopted Adolescents

Adversity during infancy can affect neurobehavioral development and perturb the maturation of physiological systems. Dysregulated immune and inflammatory responses contribute to many of the later effects on health. Whether normalization can occur following a transition to more nurturing, benevolent conditions is unclear. To assess the potential for recovery, blood samples were obtained from 45 adolescents adopted by supportive families after impoverished infancies in institutional settings (post-institutionalized, PI). Their immune profiles were compared to 39 age-matched controls raised by their biological parents (non-adopted, NA). Leukocytes were immunophenotyped, and this analysis focuses on natural killer (NK) cell populations in circulation. Cytomegalovirus (CMV) seropositivity was evaluated to determine if early infection contributed to the impact of an atypical rearing. Associations with tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ), two cytokines released by activated NK cells, were examined. Compared to the NA controls, PI adolescents had a lower percent of CD56bright NK cells in circulation, higher TNF-α levels, and were more likely to be infected with CMV. PI adolescents who were latent carriers of CMV expressed NKG2C and CD57 surface markers on more NK cells, including CD56dim lineages. The NK cell repertoire revealed lingering immune effects of early rearing while still maintaining an overall integrity and resilience.

Principles, policies, and practices: Thoughts on their integration over the rise of the developmental psychopathology perspective and into the future

Developmental psychopathology has, since the late 20th century, offered an influential integrative framework for conceptualizing psychological health, distress, and dysfunction across the lifespan. Leaders in the field have periodically generated predictions about its future and have proposed ways to increase the macroparadigm's impact. In this paper, we examine, using articles sampled from each decade of the journal Development and Psychopathology's existence as a rough guide, the degree to which the themes that earlier predictions have emphasized have come to fruition and the ways in which the field might further capitalize on the strengths of this approach to advance knowledge and practice in psychology. We focus in particular on two key themes first, we explore the degree to which researchers have capitalized on the framework's capacity for principled flexibility to generate novel work that integrates neurobiological and/or social-contextual factors measured at multiple levels and offer ideas for moving this kind of work forward. Second, we discuss how extensively articles have emphasized implications for intervention or prevention and how the field might amplify the voice of developmental psychopathology in applied settings.

Inflammatory burden of adolescents with childhood maltreatment: results from baseline data of a school cohort

Increasing studies have investigated inflammatory burden of adults with childhood adversity, but less is known about how childhood maltreatment affects the inflammation level of adolescents. Baseline data of a school cohort of physical and mental health status and life experience survey on primary and secondary school students in Anhui Province, China was used. Childhood maltreatment of children and adolescents was assessed by Chinese version of Childhood Trauma Questionnaire-Short Form (CTQ-SF). Urine samples were collected to assess levels of soluble urokinase Plasminogen Activator Receptor (suPAR), C-reactive protein (CRP) and cytokines interleukin-6 (IL-6) by enzyme-linked immunosorbent assay (ELISA). Logistic regression was conducted to examine the association between childhood maltreatment exposure and risk of high inflammation burden. A total of 844 students were included with mean age 11.41 ± 1.57 years old. Adolescents with emotional abuse were significantly more likely to have high level of IL-6 (OR = 3.59, 95% CI 1.16-11.14). In addition, adolescents with emotional abuse were more likely to show high IL-6 and high suPAR combination (OR = 33.41, 95% CI 1.69-659.22), and high IL-6 and low CRP combination (OR = 4.34, 95% CI 1.29-14.55). Subgroup analyses showed that emotional abuse was associated with high IL-6 burden among boys or adolescents with depression. Childhood emotional abuse was positively associated with higher burden of IL-6. Early detection and prevention of emotional abuse for children and adolescents, especially for boys or adolescents with depression status, may be helpful for preventing elevated inflammatory burden and related health problems.

The role of inflammation in the effects of peer victimisation and stressful life events on mental health in childhood

Background

Peer victimisation represents a salient stressor during childhood. However, studies investigating the mechanism of its impact on children's mental health typically examine socio-cognitive factors as mediators. The current study sought to provide novel insight through testing a potential biological mechanism, inflammation. It also tested for pathway-specific effects by comparing how inflammation may mediate the effect of peer victimisation and that of another important stressor in childhood: adverse life events.

Method

Data from 4,583 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) were used. Path analysis was carried out to investigate whether inflammation (IL-6 and CRP) at age 9 years mediates the effect of peer victimisation and stressful life events at age 8 years on internalising (peer and emotional) or externalising (hyperactivity and conduct) problems (measured at age 11 years), both before and after adjustment for potential confounders.

Results

IL-6 partially mediated the effect of peer victimisation on peer problems, even after adjustment for potential confounders. Inflammation did not mediate the effect of stressful life events on either type of internalising problems. Neither stressor predicted externalising problems via inflammation.

Conclusion

We did not find evidence that inflammation mediates the effect of stressful life events on mental health in childhood when they are considered alongside experiences of peer victimisation. Inflammation may already represent a form of biological embedding of peer victimisation in the early years.

Obesity, inflammation, and depression in adolescents

Background

The prevalence of depression and obesity among adolescents has markedly increased over the last few decades. A bidirectional relationship has been proposed between depression and obesity in adolescence, but it remains poorly understood. Inflammation is a phenomenon that has been implicated in both disorders. Thus, a cross-sectional study was designed to investigate inflammation as a factor in the association between obesity and depression. The goal of this study is to better understand the interplay between these two disorders.

Methods

The study sample consisted of female and male, black and white adolescents aged 15-18 years. Participants were diagnosed with major depressive disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders-5. Depression severity was determined using the Quick Inventory of Depressive Symptomatology (QIDS). Participants completed the Childhood Trust Events Survey (CTES) and received an Early Life Stress (ELS) score based on the survey results. Those with a score of ≥4 were placed in the ELS group and those with a score ≤ 3 were placed in the non-ELS group. Anthropometric measures and a Dual Energy X-ray Absorptiometry (DEXA) scan were performed for body composition. Blood samples were collected to measure inflammatory factors.

Results

Adolescents with MDD (n = 47) had significantly elevated body mass index (BMI) percentiles compared to the controls (n = 47) (77.11 ± 3.58 vs. 59.63 ± 4.40), and increased adiposity measures, including total fat (p = 0.016), trunk fat (p = 0.016), and trunk/total fat ratio (p = 0.021). Levels of C-reactive protein, tumor necrosis factor-alpha, interleukin-6, leptin, and adiponectin varied significantly between the MDD and control groups, however, significance was not retained when BMI percentile and ELS score were controlled. There was a significant and positive relationship between QIDS and multiple measures of adiposity such as BMI percentile, visceral abdominal tissue, and trunk/total ratio. Depression severity was best predicted by ELS score, visceral adipose tissue, and adiponectin level.

Conclusion

Adolescents with MDD had increased levels of inflammatory factors and many measures of adiposity. Thus, the treatment of adolescent depression should include a focus on managing body composition and reducing chronic inflammation to potentially improve treatment outcomes.

Potential peripheral biomarkers associated with the emergence and presence of posttraumatic stress disorder symptomatology: A systematic review

BACKGROUND

Evidence suggests posttraumatic stress disorder (PTSD) involves an interplay between psychological manifestations and biological systems. Biological markers of PTSD could assist in identifying individuals with underlying dysregulation and increased risk; however, accurate and reliable biomarkers are yet to be identified.

METHODS

A systematic review following the PRISMA guidelines was conducted. Databases included EMBASE, MEDLINE, and Cochrane Central. Studies from a comprehensive 2015 review (Schmidt et al., 2015) and English language papers published subsequently (between 2014 and May 2022) were included. Forty-eight studies were eligible.

RESULTS

Alterations in neuroendocrine and immune markers were most commonly associated with PTSD symptoms. Evidence indicates PTSD symptoms are associated with hypothalamic-pituitary-adrenal axis dysfunction as represented by low basal cortisol, a dysregulated immune system, characterized by an elevated pro-inflammatory state, and metabolic dysfunction. However, a considerable number of studies neglected to measure sex or prior trauma, which have the potential to affect the biological outcomes of posttraumatic stress symptoms. Mixed findings are indicative of the complexity and heterogeneity of PTSD and suggest the relationship between allostatic load, biological markers, and PTSD remain largely undefined.

CONCLUSIONS

In addition to prospective research design and long-term follow up, it is imperative future research includes covariates sex, prior trauma, and adverse childhood experiences. Future research should include exploration of biological correlates specific to PTSD symptom domains to determine whether underlying processes differ with symptom expression, in addition to subclinical presentation of posttraumatic stress symptoms, which would allow for greater understanding of biomarkers associated with disorder risk and assist in untangling directionality.

Immediate impact of child maltreatment on mental, developmental, and physical health trajectories

OBJECTIVE

The immediate impact of child maltreatment on health and developmental trajectories over time is unknown. Longitudinal studies starting in the direct aftermath of exposure with repeated follow-up are needed.

METHOD

We assessed health and developmental outcomes in 6-month intervals over 2 years in 173 children, aged 3-5 years at study entry, including 86 children with exposure to emotional and physical abuse or neglect within 6 months and 87 nonmaltreated children. Assessments included clinician-administered, self- and parent-report measures of psychiatric and behavioral symptoms, development, and physical health. Linear mixed models and latent growth curve analyses were used to contrast trajectories between groups and to investigate the impact of maltreatment features on trajectories.

RESULTS

Maltreated children exhibited greater numbers of psychiatric diagnoses (b = 1.998, p < .001), externalizing (b = 13.29, p < .001) and internalizing (b = 11.70, p < .001) symptoms, impairments in cognitive (b = -11.586, p < .001), verbal (b = -10.687, p < .001), and motor development (b = -7.904, p = .006), and greater numbers of medical symptoms (b = 1.021, p < .001) compared to nonmaltreated children across all time-points. Lifetime maltreatment severity and/or age at earliest maltreatment exposure predicted adverse outcomes over time.

CONCLUSION

The profound, immediate, and stable impact of maltreatment on health and developmental trajectories supports a biological embedding model and provides foundation to scrutinize the precise underlying mechanisms. Such knowledge will enable the development of early risk markers and mechanism-driven interventions that mitigate adverse trajectories in maltreated children.

Secretory immunoglobulin A (s-IgA) reactivity to acute psychosocial stress in children and adolescents: The influence of pubertal development and history of maltreatment

BACKGROUND

Mucosal secretory immunoglobulin A (s-IgA) is an antibody protein-complex that plays a crucial role in immune first defense against infection. Although different immune biomarkers have been associated with stress-related psychopathology, s-IgA remains poorly studied, especially in youth.

OBJECTIVES

The present study investigated how s-IgA behaves in front of acute psychosocial stress in children and adolescents, including possible variability associated with developmental stage and history of childhood maltreatment (CM).

METHODS

94 children and adolescents from 7 to 17 years (54 with a current psychiatric diagnostic and 40 healthy controls) drawn from a larger Spanish study were explored (EPI-Young Stress Project). To assess biological reactivity, participants provided five saliva samples during an acute laboratory-based psychosocial stressor, the Trier Social Stress Test for Children (TSST-C). Samples were assayed for s-IgA, as well as for cortisol. Pubertal development was ascertained by Tanner stage and CM following TASSCV criteria.

RESULTS

We observed s-IgA fluctuations throughout the stressor, indicating the validity of TSST-C to stimulate s-IgA secretion (F(4,199) = 6.200, p <.001). Although s-IgA trajectories followed a reactivity and recovery pattern in adolescents, children exhibited no s-IgA response when faced with stress (F(4,197) = 3.406, p =.010). An interaction was found between s-IgA and CM (F(4,203) = 2.643, p =.035). Interestingly, an interaction between developmental stage, CM history and s-IgA reactivity was identified (F(12,343) = 2.036, p =.017); while children non-exposed to maltreatment exhibited no s-IgA changes to acute stress, children with a history of CM showed a similar response to adolescents, increasing their s-IgA levels after the psychosocial stressor.

CONCLUSION

Acute psychosocial stress stimulates s-IgA secretion, but only after puberty. However, children with a history of maltreatment exhibited a response resembling that of adolescents, suggesting an early maturation of the immune system. Further studies are needed to clarify the validity of s-IgA as an acute stress biomarker, including additional measures during stress exposure.

The relations between C-reactive protein and trauma exposure, PTSD and depression symptoms, and PTSD psychotherapy treatment response in treatment seeking veterans and service members

While inflammatory markers have been implicated in the link between PTSD and poor health outcomes, there is a paucity of research investigating C-reactive protein (CRP) and psychotherapy treatment response for posttraumatic stress disorder (PTSD). The present study utilized a large, well-characterized sample of veterans and service members (N = 493) engaged in intensive psychotherapy to investigate the associations between CRP, trauma exposure, related variables, and PTSD and depression, as well as investigating if CRP was associated with PTSD psychotherapy treatment response. Bivariate correlation results indicate that CRP was significantly associated with BMI (r = 0.48) and severity of experiences of childhood physical and sexual abuse (r = 0.14 and 0.15, respectively) and was not significantly associated with baseline PTSD total symptom severity, PTSD symptom clusters, or depression symptom severity (rs ranging from -0.03 to 0.04). In multivariate regression models investigating if CRP and related variables were associated with PTSD baseline symptom severity, CRP was not a significant predictor (β = -0.03). Hierarchical linear modeling did not identify CRP as a significant predictor of PTSD psychotherapy outcome. Given that findings indicate that CRP was broadly elevated in this treatment seeking sample but not associated with PTSD and depression symptom severity, results suggest CRP may not be a specific biomarker for PTSD or depression but may be elevated in psychiatric disease more generally.

How Anxious are German Preschool Children?

The experience of fear is universal and is among the earliest of all forms of psychopathology, if excessively present. To prevent negative developmental outcomes due to early-onset excessive fears in children, it is important to systematically assess these experiences as early as possible. Using the preschool anxiety scale (PAS), we aimed to assess the frequency and structure of anxiety symptoms of 489 preschool-aged children raised in their biological family and 88 raised in foster care (as a high-risk sample) in Germany. While these young children displayed the same types of anxiety most commonly as young children in other countries, the overall occurrence seems to be reported less often by parents in Germany compared to parents from other countries. Anxiety symptoms clustered into five correlated factors (generalized anxiety, social anxiety, obsessive-compulsive disorder (OCD), physical injury fear and separation anxiety). Young children in foster care exhibited more OCD and significantly less social anxiety symptoms indicating early repetitive and social disturbances in children in foster care.

Immune and Epigenetic Pathways Linking Childhood Adversity and Health Across the Lifespan

Childhood adversity is associated with a host of mental and physical health problems across the lifespan. Individuals who have experienced childhood adversity (e.g., child abuse and neglect, family conflict, poor parent/child relationships, low socioeconomic status or extreme poverty) are at a greater risk for morbidity and premature mortality than those not exposed to childhood adversity. Several mechanisms likely contribute to the relationship between childhood adversity and health across the lifespan (e.g., health behaviors, cardiovascular reactivity). In this paper, we review a large body of research within the field of psychoneuroimmunology, demonstrating the relationship between early life stress and alterations of the immune system. We first review the literature demonstrating that childhood adversity is associated with immune dysregulation across different indices, including proinflammatory cytokine production (and its impact on telomere length), illness and infection susceptibility, latent herpesvirus reactivation, and immune response to a tumor. We then summarize the growing literature on how childhood adversity may alter epigenetic processes. Finally, we propose future directions related to this work that have basic and applied implications.

Childhood adversity correlates with stable changes in DNA methylation trajectories in children and converges with epigenetic signatures of prenatal stress

Childhood maltreatment (CM) is an established major risk factor for a number of negative health outcomes later in life. While epigenetic mechanisms, such as DNA methylation (DNAm), have been proposed as a means of embedding this environmental risk factor, little is known about its timing and trajectory, especially in very young children. It is also not clear whether additional environmental adversities, often experienced by these children, converge on similar DNAm changes. Here, we calculated a cumulative adversity score, which additionally to CM includes socioeconomic status (SES), other life events, parental psychopathology and epigenetic biomarkers of prenatal smoking and alcohol consumption. We investigated the effects of CM alone as well as the adversity score on longitudinal DNAm trajectories in the Berlin Longitudinal Child Study. This is a cohort of 173 children aged 3-5 years at baseline of whom 86 were exposed to CM. These children were followed-up for 2 years with extensive psychometric and biological assessments as well as saliva collection at 5 time points providing genome-wide DNAm levels. Overall, only a few DNAm patterns were stable over this timeframe, but less than 10 DNAm regions showed significant changes. At baseline, neither CM nor the adversity score associated with DNAm changes. However, in 6 differentially methylated regions (DMRs), CM and the adversity score significantly moderated DNAm trajectories over time. A number of these DMRs have previously been associated with adverse prenatal exposures. In our study, children exposed to CM also presented with epigenetic signatures indicative of increased prenatal exposure to tobacco and alcohol, as compared to non-CM exposed children. These epigenetic signatures of prenatal exposure strongly correlate with DNAm regions associated with CM and the adversity score. Finally, weighted correlation network analysis revealed a module of CpGs exclusively associated with CM. While our study identifies DNAm loci specifically associated with CM, especially within long non-coding RNAs, the majority of associations were found with the adversity score with convergent association with indicators of adverse prenatal exposures. This study highlights the importance of mapping not only of the epigenome but also the exposome and extending the observational timeframe to well before birth.

The pediatric buccal epigenetic clock identifies significant ageing acceleration in children with internalizing disorder and maltreatment exposure

Background

Studies reporting accelerated ageing in children with affective disorders or maltreatment exposure have relied on algorithms for estimating epigenetic age derived from adult samples. These algorithms have limited validity for epigenetic age estimation during early development. We here use a pediatric buccal epigenetic (PedBE) clock to predict DNA methylation-based ageing deviation in children with and without internalizing disorder and assess the moderating effect of maltreatment exposure. We further conduct a gene set enrichment analysis to assess the contribution of glucocorticoid signaling to PedBE clock-based results.

Method

DNA was isolated from saliva of 158 children [73 girls, 85 boys; mean age (SD) = 4.25 (0.8) years] including children with internalizing disorder and maltreatment exposure. Epigenetic age was estimated based on DNA methylation across 94 CpGs of the PedBE clock. Residuals of epigenetic age regressed against chronological age were contrasted between children with and without internalizing disorder. Maltreatment was coded in 3 severity levels and entered in a moderation model. Genome-wide dexamethasone-responsive CpGs were derived from an independent sample and enrichment of these CpGs within the PedBE clock was identified.

Results

Children with internalizing disorder exhibited significant acceleration of epigenetic ageing as compared to children without internalizing disorder (F_1,147 = 6.67, p = .011). This association was significantly moderated by maltreatment severity (b = 0.49, 95% CI [0.073, 0.909], t = 2.322, p = .022). Children with internalizing disorder who had experienced maltreatment exhibited ageing acceleration relative to children with no internalizing disorder (1–2 categories: b = 0.50, 95% CI [0.170, 0.821], t = 3.008, p = .003; 3 or more categories: b = 0.99, 95% CI [0.380, 1.593], t = 3.215, p = .002). Children with internalizing disorder who were not exposed to maltreatment did not show epigenetic ageing acceleration. There was significant enrichment of dexamethasone-responsive CpGs within the PedBE clock (OR = 4.36, p = 1.65*10–6). Among the 94 CpGs of the PedBE clock, 18 (19%) were responsive to dexamethasone.

Conclusion

Using the novel PedBE clock, we show that internalizing disorder is associated with accelerated epigenetic ageing in early childhood. This association is moderated by maltreatment severity and may, in part, be driven by glucocorticoids. Identifying developmental drivers of accelerated epigenetic ageing after maltreatment will be critical to devise early targeted interventions.

Applications of psychoneuroimmunology models of toxic stress in prevention and intervention efforts across early development

Although evidence supporting psychoneuroimmunology (PNI) models of toxic stress have emerged over the past decade, the PNI field has struggled to integrate these important findings into real-world practical applications. There is great potential for these models to reduce the societal burden of childhood adversity by facilitating early detection and prevention with those children and adolescents at greatest risk for stress-related physical and psychological disorders. But further research is needed to validate and scale developmentally appropriate interventions with specific immune and endocrine mechanism-based targets that are developmentally sensitive. The allostatic load and additive PNI models of toxic stress exposure in youth are summarized. These models highlight the importance of integrating a standardized screening of environmental and interpersonal risk factors with stable and scalable cognitive and biological markers of risk. PNI models of toxic stress illustrate the need for intervention delivery as early as possible to prevent negative health outcomes in youth and comprehensive screening efforts would facilitate the deployment of community and family level interventions. This review discusses practical applications of toxic stress models that are currently under investigation, clarifies key obstacles, such as research gaps and scalability, and provides potential solutions, including cross-disciplinary partnerships.